25. Cardioprotection in pediatric oncology

  1. Ross Pinkerton MB, BCh, BaO, MD Executive Director, Division of Oncology2,
  2. Ananth Shankar MD, FRCPCH Consultant in Paediatric and Adolescent Oncology3 and
  3. Katherine K. Matthay BA, MD Mildred V. Strouss Professor of Translational Oncology, Director, Pediatric Hematology-Oncology4
  1. Ananth Shankar

Published Online: 8 MAY 2013

DOI: 10.1002/9781118625309.ch25

Evidence-Based Pediatric Oncology

Evidence-Based Pediatric Oncology

How to Cite

Shankar, A. (2013) Cardioprotection in pediatric oncology, in Evidence-Based Pediatric Oncology (eds R. Pinkerton, A. Shankar and K. K. Matthay), John Wiley & Sons, Ltd, Oxford. doi: 10.1002/9781118625309.ch25

Editor Information

  1. 2

    Royal Children's Hospital, Children's Health Queensland, Brisbane, QLD, Australia

  2. 3

    University College London Hospitals NHS Foundation Trust London, UK

  3. 4

    Department of Pediatrics, UCSF School of Medicine and, UCSF Benioff Children's Hospital, San Francisco, CA, USA

Author Information

  1. University College London Hospitals NHS Foundation Trust, London, UK

Publication History

  1. Published Online: 8 MAY 2013
  2. Published Print: 20 MAY 2013

ISBN Information

Print ISBN: 9780470659649

Online ISBN: 9781118625309



  • anthracycline;
  • cardiac disease;
  • cardioprotective agents;
  • childhood;
  • dexrazoxane


Cardiac disease in childhood cancer survivors has been recognized as a major cause of premature deaths and morbidity. Anthracyclines and cardiac radiation are the main offenders and recognition has been documented since the 1970s. The childhood acute lymphoblastic leukaemia collaborative group performed a meta-analysis on acute lymphoblastic leukemia (ALL) trials started between 1972 and 1984 that randomized the use of anthracyclines and methods of reducing cardiotoxicity (use of dexrazoxane, type of anthracycline used, method of administration, bolus versus infusion). The assessment of dexrazoxane as a cardioprotective agent falls into two categories: first, whether it provides a useful cardioprotective effect and second, whether its use affects event-free survival by decreasing the efficacy of anthracyclines, reducing dose intensity of the treatment regimen or causing life-threatening toxicity.